| NPI | 1972686079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NJ 25MA07363300) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA07363300) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-03-16 |