| NPI | 1659909760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 99884) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 86028) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-11-12 |