| NPI | 1902409196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 10533) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 62036984) |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2020-11-19 |