| NPI | 1356570212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 2097) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA os016180) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 60 251997) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2019-10-22 |