| NPI | 1063633188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 045336) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 233705) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-01-02 |