| NPI | 1366614406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB08845000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS 8450) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2022-09-12 |