| NPI | 1528649100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: NV DO4107) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NV DO4107) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2026-07-14 |