| NPI | 1356410443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL OS6109) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 59-3207217) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-09-19 |