| NPI | 1770591455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 86643) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 213014) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA06837700) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME132633) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2025-12-02 |