| NPI | 1699895839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS014801) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 307196-01) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA OS014801) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2024-07-10 |