| NPI | 1164089058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0073620) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102207354) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA OS023243) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CO DR.0073620) | |
| Enumeration Date | 2019-05-26 |
| Last Update Date | 2024-07-18 |