| NPI | 1427378843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 56680) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA09886400) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2018-09-21 |