| NPI | 1992804884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: NY 116567) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 116567) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2017-09-20 |