| NPI | 1982137352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 276655) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 276655) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2022-08-24 |