| NPI | 1760825210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 293785-01) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: NY 293785-01) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2020-07-22 |