| NPI | 1457397606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 222712) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY 222712-1) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 222712) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 222712) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2011-04-13 |