| NPI | 1386818607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 92857) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA C55791) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME96901) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2022-07-26 |