| NPI | 1467870436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA12626000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX R5506) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2026-07-09 |