| NPI | 1043672090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: VA 0101284910) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 21161) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2025-06-26 |