| NPI | 1669567202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25ma08317000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 191224) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2012-02-01 |