| NPI | 1730213240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MI 4301088175) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PA MD439784) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NJ 25MA08725900) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2021-06-30 |