| NPI | 1366505281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY A293361-01) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102201765) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2024-07-24 |