NPI | 1154641702 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 277493) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 277493) |
Enumeration Date | 2010-06-06 |
Last Update Date | 2018-03-17 |