| NPI | 1366755811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 211001) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301097001) |
| 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: MI 4301097001) | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2023-08-08 |