| NPI | 1316059272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 01030273A) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 270910-20) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 270910-20) | |
| 2084N0600X (Licence: WI 270910-20) | |
| 208VP0000X (Licence: WI 270910-20) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 270910-20) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-09-11 |