| NPI | 1588843163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 251765) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101242371) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2018-05-30 |