| NPI | 1952348195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA63969) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 210854) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2016-11-14 |