| NPI | 1710203047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 9189225-1205) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NV 23014) |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2024-10-28 |