| NPI | 1053361154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME140504) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NY 201050) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 201050) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-03-25 |