| NPI | 1164556692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301086085) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: MI 4301086085) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 4301086085) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301086085) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2025-03-14 |