| NPI | 1841249497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA06914500) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD067120L) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-12-03 |