| NPI | 1326023128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 235170) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY 235170) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2023-07-05 |