| NPI | 1114309267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 89733) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 89733) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102204647) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0102204647) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2023-09-27 |