| NPI | 1396023701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB09901300) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 277815) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MA 289323) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2025-12-16 |