| NPI | 1255523551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME99148) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 26157) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301090436) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2023-05-12 |