| NPI | 1205837374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 056454) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 056454) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2023-05-12 |