| NPI | 1205063211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AR E-9691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 13487) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AR E-9691) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO 49437) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2021-07-12 |