| NPI | 1265877385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10077900) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 288437-1) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2019-03-12 |