| NPI | 1649304056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL os10065) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS10065) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2025-04-03 |