| NPI | 1790725661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA08268500) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 229572) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-03-09 |