| NPI | 1114180882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB08316500) |
| Additional Taxonomies | 208VP0000X (Licence: NJ 25MB08316500) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2025-12-09 |