| NPI | 1164491890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 220248) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 220248) |
| 173000000X Legal Medicine (Licence: NY 220248) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2021-03-10 |