| NPI | 1053790501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MT 89120) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS14873) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2024-12-03 |