| NPI | 1811155047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB10039600) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DE C2-0011980) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA OS016086) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2025-07-09 |