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 |