| NPI | 1548421191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME112791) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 277799) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2023-03-09 |