| NPI | 1689675530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX J5057) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 175404-2) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2019-01-07 |