| NPI | 1235104852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 167020) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA05366600) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-07-08 |