| NPI | 1134623408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 337671) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: NY 337671) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 337671) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-09-17 |