| NPI | 1619400967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2024-0873) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 318576) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VT 042.0017017) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2024-12-04 |