| NPI | 1548656770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OR MD222220) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD471173) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2025-07-10 |