| NPI | 1235121351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 140796) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 140796-1) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2020-02-21 |