| NPI | 1447272901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 187228) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY A187228) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-05-07 |