| NPI | 1154346302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 042845) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 042845) |
| 208VP0000X (Licence: CT 042845) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-12-03 |