| NPI | 1952938680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: RI MD20662) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 208100000) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-05-13 |