| NPI | 1124462056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: NV 16946) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NV 16946) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2026-04-28 |