| NPI | 1174536270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA 46250) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IA 46250) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: IA MD-46250) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2024-10-18 |