| NPI | 1518224583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NY 287516) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA10069200) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 287516) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NJ 25MA10069200) | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2018-03-17 |