| NPI | 1669009346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 340520-01) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 109952) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MA 1018378) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX W2295) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-07-06 |