| NPI | 1801062443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NJ 25MB08919200) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OT012043) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB08919200) | |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2011-08-30 |