| NPI | 1487953014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: RI MD18150) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA0952500) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MT207791) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: CT 061507) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2022-02-21 |