NPI | 1386646305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA07954300) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 141612) |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA07954300) | |
Enumeration Date | 2005-08-10 |
Last Update Date | 2011-04-01 |