| NPI | 1679552111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 162737) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 162737) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 162737) | |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: NY 162737) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 162737) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 162737) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2014-01-31 |