| NPI | 1760404057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS006878L) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: DE C20004708) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-10-19 |