| NPI | 1992974976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA va0101248599) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 60245963) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2013-02-05 |