| NPI | 1073550562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 242475) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301064159) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-06-16 |