| NPI | 1790282127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB11908500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 312542) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-07-17 |