| NPI | 1023432127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 293378) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 293378) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2022-12-29 |