| NPI | 1558384867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 227788) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD451984) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA07902500) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-07-02 |