| NPI | 1134104433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 4065) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4065) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2024-01-16 |