| NPI | 1750485991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 1842451) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NY 184245) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2024-03-14 |