| NPI | 1992773899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 176987) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY 176987-1) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2009-07-30 |