| NPI | 1578553269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 170605) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 75663) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MA 75663) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2014-07-24 |