| NPI | 1922343078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: NY 269076-1) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 269076-1) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2014-08-07 |