| NPI | 1457435737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 211161) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 211161) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NY 211161) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2015-09-14 |