| NPI | 1982044939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 283427) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB09927100) | |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2016-09-09 |