| NPI | 1497132518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101272717) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D009124) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 298280) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 298280) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2024-08-14 |