| NPI | 1629232129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 265584) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 265584-1) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2020-05-18 |