| NPI | 1265627079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA L-226503) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 253179) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2019-03-26 |