| NPI | 1417234774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 148220) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 148220) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2013-01-28 |