| NPI | 1124389028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA09838900) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD457475) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2016-12-20 |