| NPI | 1891880365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 198192) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 198192) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2017-02-03 |