| NPI | 1518463090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 5101027616) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10066768) |
| 207R00000X Internal Medicine (Licence: IL 125.072538) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20034) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-09-09 |