| NPI | 1316138845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 245314) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 061971) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2025-10-20 |