| NPI | 1811961139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 292641) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 10230) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2019-02-19 |