| NPI | 1710054002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 146182) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 146182) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-03-12 |