| NPI | 1528450236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 323196-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.074444) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 125074444) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA S51215873) | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2023-06-29 |