| NPI | 1598844433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: NY 209924) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 209924) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |