| NPI | 1477512150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 220607) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA11648000) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A81489) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2023-03-21 |