| NPI | 1063825792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB11870000) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB11870000) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2026-01-12 |