| NPI | 1427283613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS13928) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OT013134) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL OS13928) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2023-02-10 |