| NPI | 1639313802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NV 15667) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 276104) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2019-11-11 |