| NPI | 1134740301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 5101027830) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT019842) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-08-19 |