| NPI | 1689849945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO DR.0051653) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A103068) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2015-0595) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2026-01-27 |