| NPI | 1558459487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB07663200) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB07663200) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MB07663200) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |