| NPI | 1619921608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 218719) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 225796) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2010-03-03 |