| NPI | 1629102421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA45276) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 156355-1) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD043022E) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |