| NPI | 1457880551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2017017599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2017017599) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD474096) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2021-07-27 |