| NPI | 1699751685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA048587) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 158536) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2023-03-07 |