| NPI | 1518995588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA06235300) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 189863-1) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-08 |