| NPI | 1225416241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 291862-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 291862-1) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 291862-1) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 291862-1) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2020-09-30 |