| NPI | 1396066627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA08837900) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MA08837900) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2014-06-27 |