NPI | 1407056807 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 263750) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 263750) |
Enumeration Date | 2007-07-23 |
Last Update Date | 2021-06-04 |