| NPI | 1104959527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA 64221) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 197575) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2008-10-26 |