| NPI | 1184868531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 270951) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 270951) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 270951) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2025-12-04 |