| NPI | 1306874441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA08249600) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NJ 25MA08249600) |
| 207Q00000X Family Medicine (Licence: PA MD421524) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD421524) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2026-05-20 |