| NPI | 1902962095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081H0002X (Licence: NY 237108) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 237108) |
| Enumeration Date | 2006-12-31 |
| Last Update Date | 2016-10-26 |