| NPI | 1639285182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA MD00046493) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00046493) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2026-03-05 |