| NPI | 1982757837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS15823) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB08719300) |
| 207R00000X Internal Medicine (Licence: MA 229614) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-04-06 |