| NPI | 1730746496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2025-02926) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2025-02926) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-08-21 |