| NPI | 1225325343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB09749000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OT014359) |
| Enumeration Date | 2011-07-10 |
| Last Update Date | 2021-11-08 |