| NPI | 1598119190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 12011553-1204) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 12011553-1204) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2026-04-21 |