| NPI | 1851365449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 163710) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 163710) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CT 035038) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2020-05-04 |