| NPI | 1174722268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA12488000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD445423) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2025-03-05 |