| NPI | 1114005360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 134853-1) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY 134853-1) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 134853-1) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-03-07 |