| NPI | 1003818584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 159346) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: NY 159346) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NY 159346) | |
| Enumeration Date | 2005-08-13 |
| Last Update Date | 2023-03-07 |