| NPI | 1417916222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2001014708) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 2001014708) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2023-09-29 |