| NPI | 1952386518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB07701500) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 231625) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2023-03-07 |