| NPI | 1194136036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD185860) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11211974-1205) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: UT 11211974-1205) | |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2023-02-10 |