| NPI | 1245886621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MA 3019459) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 37176) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2025-07-14 |