| NPI | 1003105792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 303794) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 303794) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2020-06-28 |