| NPI | 1114970464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 31092) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 32092) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN 31092) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-08-29 |