| NPI | 1972762227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA C149672) |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: PA MD491229) |
| 261QX0100X Clinic/Center, Occupational Medicine (Licence: CA C149672) | |
| 261QX0100X Clinic/Center, Occupational Medicine (Licence: FL ME112545) | |
| 261QX0100X Clinic/Center, Occupational Medicine (Licence: NY 270398-01) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2025-07-18 |