| NPI | 1750689352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 289128) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 56506) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO DR0054623) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ Unknown (resident)) | |
| Enumeration Date | 2011-03-05 |
| Last Update Date | 2020-05-17 |