| NPI | 1306028691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 279312) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 50954) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD448153) | |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2016-08-31 |