| NPI | 1821713843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 029097) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2023-04-27 |