| NPI | 1164926911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 321118) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 321118) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OK 41134) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2024-09-25 |