| NPI | 1386829208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2008-00366) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 238535) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2025-10-08 |