| NPI | 1619902616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A114470) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 228665) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD438591) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WY TL6267) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-06-18 |