| NPI | 1326562711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 318760) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 318760) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2022-09-01 |