| NPI | 1588921365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2018-01562) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2018-01562) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2023-12-18 |