| NPI | 1962765461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS13947) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB09801400) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MB09801400) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2023-02-22 |