| NPI | 1154487528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 243989) |
| Additional Taxonomies | 2081H0002X (Licence: NY 243989) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 243989) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2014-06-28 |