| NPI | 1275791063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD438971) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 246500) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2010-10-14 |