| NPI | 1366440133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 134874) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 134874) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 134874) | |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: NY 134874) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 134874) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 137874) | |
| 209800000X Legal Medicine (Licence: NY 134874) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2010-10-22 |