| NPI | 1457550519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 252770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116019442) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2014-01-24 |