| NPI | 1598751323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NH 8092) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 8092) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MA 70585) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MA 70585) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2022-09-06 |