| NPI | 1629228010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 176034) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.008368) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102202192) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB05670800) | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2014-03-31 |