| NPI | 1013205400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB09693800) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MB09693800) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2021-11-21 |