| NPI | 1548211519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: RI MD09988) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 038036) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 038036) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 038036) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2023-03-21 |