| NPI | 1336482694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME136367) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME136367) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 290474-1) | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2023-06-06 |