NPI | 1790026011 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 1790026011) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 276396) |
Enumeration Date | 2013-03-12 |
Last Update Date | 2025-01-10 |