| NPI | 1699937722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 257100) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: NY 257100) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 257100) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 257100) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2021-04-23 |