| NPI | 1053514653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09887900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS10552) |
| 208D00000X General Practice (Licence: NY 238708) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS10552) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL os10552) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB09887900) | |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2025-07-28 |