| NPI | 1306853155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 156178) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC MD 34323) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2024-07-18 |