| NPI | 1184871394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS015602) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.011028) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10487200) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2022-02-22 |