| NPI | 1912279977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NJ 25MA09272600) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA09272600) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NJ 25MA09272600) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PA MD444614) | |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2023-11-27 |