| NPI | 1700808466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 240076) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 240076) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 240076) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2012-02-25 |