| NPI | 1487158960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2022-03037) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11410624-1204) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2026-09-21 |