| NPI | 1861534331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 301809) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101048052) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2021-01-26 |