| NPI | 1811429715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 314871) |
| Additional Taxonomies | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: MO 2018018673) |
| 363A00000X Physician Assistant (Licence: NY 314871) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2024-03-06 |