| NPI | 1750373718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 8278) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 30879) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2023-10-01 |