| NPI | 1093753329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NC 200400934) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PA OS-010979L) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: SC 1146) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: GA 53011) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-06-23 |