| NPI | 1609169697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 260559) |
| Additional Taxonomies | 2081H0002X (Licence: NY 260559) |
| 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: NY 260559) | |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: NY 260559) | |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: NY 260559) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 260559) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 260559) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2011-05-24 |