| NPI | 1275652216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD434605) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT181845) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 243966) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-07-24 |