| NPI | 1407153265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 09614400) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 53503) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2016-12-23 |