| NPI | 1700222809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2019-00928) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2019-00928) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2024-09-12 |