| NPI | 1629632211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 102584) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102206854) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2025-01-24 |