| NPI | 1780668764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA07872400) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 2355541) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-03-07 |