| NPI | 1942443452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: NY 269366) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 269366) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2019-02-24 |