| 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 |