| NPI | 1649351214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 196782) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 196782) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2024-06-18 |