| NPI | 1669663290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV DO2831) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 245835-1) |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 5767466-1204) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 245835-1) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2021-03-15 |