| NPI | 1255622585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 078068) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 250184) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 35704) | |
| 208D00000X General Practice (Licence: NY 254654-1) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2018-07-05 |