| NPI | 1619983400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME134195) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY A192152-1) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY A192152-1) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-03-17 |