| NPI | 1730569419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 74717) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD462364) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 302892) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2024-10-03 |