| NPI | 1811985872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA05559200) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: NJ 25MA05559200) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2011-04-01 |