| NPI | 1518935089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA07073000) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY 229268-1) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2016-02-03 |