| NPI | 1356760714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DE C1-0013714) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA10356700) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2021-02-27 |