| NPI | 1396725081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 210710) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 210710) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 210710) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2008-06-16 |