| NPI | 1710500400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101278095) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0116034581) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101278095) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-07-09 |