| NPI | 1043276645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SD 7154) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS013636) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SD 7154) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2022-04-04 |