| NPI | 1184252314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 335131) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA12441400) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-11-12 |