| NPI | 1912576877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 346290) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS023269) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2026-07-15 |