| NPI | 1780038307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 311123) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 311123) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2023-08-21 |