| NPI | 1649470295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NJ MA053782) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: NJ MA053782) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ MA053782) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2008-05-21 |