| NPI | 1154368819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PA MD421553) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NJ 25MA07120600) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2010-04-30 |