| NPI | 1730899394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 11660) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 049183) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-02-01 |