| NPI | 1326078460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 227375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 227375) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2018-03-17 |