| NPI | 1407018666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA08569900) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD443429) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2025-01-10 |