| NPI | 1003842022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA07557300) |
| Additional Taxonomies | 208VP0000X (Licence: NJ 25MA07557300) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2026-02-18 |