| NPI | 1700894110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 222300) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 222300) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA0719390) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MA0719390) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2018-03-17 |