| NPI | 1982021374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 292516) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2015013441) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2021-04-30 |