| NPI | 1912161498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 54645) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD454619) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 265806) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-07-08 |