| NPI | 1538255633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME110675) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 167617) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-08-03 |