| NPI | 1023026127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS8691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS8691) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL OS8691) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2023-04-21 |