| NPI | 1982877106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 260632) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 260632) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 260632) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2024-11-12 |