| NPI | 1669689865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2022-02036) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 059042) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-02-08 |