| NPI | 1487632881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 9701373) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NC 97-01373) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2024-02-22 |