| NPI | 1689634636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD457140) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 236998) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CT 048733) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD457140) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2016-05-17 |