| NPI | 1790808509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD047895L) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 53987-20) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 240989) | |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2023-03-07 |