| NPI | 1942629647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 301567) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 301567) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: NY 301567) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NY 301567) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-10-28 |