| NPI | 1942837455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 339920) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0076376) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL OS19350) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX V0720) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-07-30 |