| NPI | 1760405807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 193217) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 193217) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-07-03 |