| NPI | 1154581619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 261708) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 261708) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA OS015183) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB09022300) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2016-08-24 |