| NPI | 1104919109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA08126100) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 228663) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2015-12-02 |