| NPI | 1073587853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME58516) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA47582) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2024-02-22 |