| NPI | 1295885374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101236767) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 241981) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 241981) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-03-10 |