| NPI | 1881757151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P9972) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB08571600) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 242569) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB08571600) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX P9972) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2015-09-16 |