| NPI | 1114371754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 310535) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD466730) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2021-11-11 |