NPI | 1134305311 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 201787) |
Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 201787) |
204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 201787) | |
Enumeration Date | 2008-01-17 |
Last Update Date | 2023-01-27 |