| NPI | 1295068476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10795000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS016300) |
| Enumeration Date | 2009-09-07 |
| Last Update Date | 2020-07-31 |