| NPI | 1770833188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 1770833188) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 86634) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2020-09-13 |