| NPI | 1639277528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA05023500) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA50235) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-04-27 |