| NPI | 1114920675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 28282) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 28282) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2021-02-10 |