| NPI | 1063708279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2018-00639) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DC 0) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NC 2018-00639) | |
| 208600000X Surgery (Licence: MA 0) | |
| Enumeration Date | 2011-06-26 |
| Last Update Date | 2023-02-09 |