| NPI | 1104099910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MB08583100) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ N/A) |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2020-02-13 |