| NPI | 1134740301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 335037) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 335037) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 5101027830) | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2025-08-29 |