| NPI | 1669483905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 297976) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: HI MD-17099) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A55096) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2023-03-07 |