| NPI | 1104893619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 231492) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 231492) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 231492) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2012-05-07 |