| NPI | 1497138010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0102205969) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA OT016687) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA OT016687) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2020-07-10 |