| NPI | 1811155781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 244611) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD438096) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2010-00042) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2014-06-18 |