| NPI | 1992123947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S1977) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 315270-01) |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2024-12-13 |