| NPI | 1881000743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MB10528700) |
| Additional Taxonomies | 208VP0000X (Licence: NJ 25mb10528700) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25mb10528700) | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2021-11-18 |