| NPI | 1679983738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL 137976) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 290769) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2023-02-15 |