| NPI | 1568667392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MB07721400) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB07721400) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2015-11-10 |