| NPI | 1689136186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB11827000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 328904) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-08-03 |