| NPI | 1265566335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD451291) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 219401) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 50306) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NE 28999) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2024-07-10 |