| NPI | 1700917150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0068116) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA08050700) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: DE C1-0008523) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MA08050700) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: DE C1-0008523) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD MD0068116) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-10-22 |