| NPI | 1083153910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ID O-1469) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: ID O-1469) |
| Enumeration Date | 2017-02-12 |
| Last Update Date | 2021-07-01 |