| NPI | 1568651842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KY 35781) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 35781) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2025-04-06 |