| NPI | 1457712010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS020533) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB11144600) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2026-06-04 |