| NPI | 1134142219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 186976) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA074384) |
| 207R00000X Internal Medicine (Licence: NJ MA074384) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-07-19 |