| NPI | 1134445109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME150056) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 16193) |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 88628611205) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2022-06-24 |