| NPI | 1356781835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OR 186251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT015459) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60569916) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA OL60463713) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A15226) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2022-05-09 |