| NPI | 1649394610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 18876701) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2012-0785) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2023-03-07 |