| NPI | 1518959212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 227736) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 227736) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2023-04-18 |