| NPI | 1992798813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD431776) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA068155) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2021-06-22 |