| NPI | 1124459722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 124667) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 124667) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2013-12-06 |