| NPI | 1891079455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A129917) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 944736) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2021-10-21 |