| NPI | 1215434428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 327050) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 75844) |
| 208VP0000X (Licence: NY 327050) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2025-11-25 |