| NPI | 1316158397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 156137) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 156137-1) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 156137-1) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NY 156137-1) | |
| 2084P0005X Psychiatry & Neurology Neurodevelopmental Disabilities (Licence: NY 156137-1) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2015-10-26 |