| NPI | 1154070670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 342610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 294097) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-08-03 |