| NPI | 1962470815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: NY 179663) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 179663) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-03-31 |