| NPI | 1164503504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2014-00818) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101251390) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 240977) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2023-09-25 |