| NPI | 1467564732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME110950) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MD D0060872) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-09-06 |