| NPI | 1831223700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 028660) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 165617) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD 067735L) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |