| NPI | 1588656714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME141036) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 183234) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-04-07 |