| NPI | 1255919353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME164997) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2026-04014) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 206-04014) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2026-08-13 |