| NPI | 1932148459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME95791) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME95791) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 214667) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-05-30 |