| NPI | 1649899097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX U0821) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX U0821) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX U0821) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2025-09-25 |