| NPI | 1063732998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A12226) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A12226) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 288011) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2021-01-08 |