| NPI | 1548429871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 201101502) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 247033) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101246867) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2021-03-26 |