| NPI | 1477866986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA09463300) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DE C1-0010926) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2021-11-08 |