| NPI | 1386382596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 13522) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 047670) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 301455) | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-05-26 |