| NPI | 1083681738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD430324) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 5999930-1205) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 230199) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2008-12-14 |