| NPI | 1831331388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 52074) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 255564) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 255564) | |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2024-11-01 |