| NPI | 1245356971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA68025) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD054441L) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2024-08-20 |