| NPI | 1285715664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 9700837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9700837) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 9700837) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2025-02-27 |