| NPI | 1629005350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 039735) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 39735) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2021-07-24 |