| NPI | 1548971831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL EDWARD DEJAC Md 716-883-0515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2025-12-08 |