| NPI | 1285600452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME161495) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 51654) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SD 5183) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-10-10 |