| NPI | 1922592476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 323849-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301114809) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301114809) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2023-06-20 |