NPI | 1962643866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 252207) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 252207) |
Enumeration Date | 2009-03-23 |
Last Update Date | 2014-01-23 |