| NPI | 1124036694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NC 2008-00005) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0063386) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 2306951) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-12-03 |