| NPI | 1376795310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 250526) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 250526) |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2021-08-30 |