| NPI | 1396298980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 023023) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 321499) |
| 208D00000X General Practice (Licence: PR 023023) | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2023-08-18 |