| 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 |