| NPI | 1154648475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 262319) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 262319) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 262319) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2015-10-15 |