| NPI | 1457883878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MI 5101025731) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101023042) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2023-04-21 |