| NPI | 1245422252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 242563) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD431928) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2021-08-13 |