| NPI | 1104388073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA OS025687) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DE C2-0024484) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2026-08-03 |