| NPI | 1578145751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB13120800) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 336261) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA OS026040) | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2026-09-01 |