NPI | 1710975859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA05980300) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA05980300) |
204R00000X Electrodiagnostic Medicine (Licence: NJ 25MA05980300) | |
Enumeration Date | 2005-10-12 |
Last Update Date | 2012-10-17 |