| NPI | 1376771030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0059606) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 270558) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2025-10-29 |