| NPI | 1740937663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA 029604) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 40qa02016100) |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-03-10 |