| NPI | 1871685404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 204322) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 204322) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 204322) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-04-04 |