| NPI | 1437310448 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA08277400) | 
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MA08277400) | 
| Enumeration Date | 2008-06-23 | 
| Last Update Date | 2021-05-12 |