| NPI | 1790765667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 246110) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT179687) |
| 208100000X Physical Medicine & Rehabilitation (Licence: RI MD13171) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2011-00970) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: RI MD13171) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2025-07-17 |