| NPI | 1134143639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ MA08907500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD420498) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD420498) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2017-01-12 |