| NPI | 1780817585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA OS016167) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA os016167) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10127000) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2024-05-07 |