| NPI | 1720109689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MA 221037) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 221037) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2025-10-02 |