| NPI | 1689945495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL OS17817) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS 4942) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2023-01-24 |