| NPI | 1942494414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PR 18259) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 280978) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2023-02-07 |