| NPI | 1528182532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA C129385) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: CA C129385) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA C129385) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 51438) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2024-04-28 |