| NPI | 1912944539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA05920200) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 57990) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2016-04-05 |