| NPI | 1912063934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 252259) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT184563) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2013-12-30 |