| NPI | 1538556733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MA10851300) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD471090) |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2023-09-06 |