| NPI | 1215257217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0082490) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA09515800) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD451865) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2023-08-03 |