| NPI | 1548496995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D77551) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA12040300) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD448094) | |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2025-02-26 |