| NPI | 1063703429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 267257) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A135316) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 267257) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2016-09-02 |