| NPI | 1770572893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN 24642) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 042978) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 8397828-1205) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2019-10-20 |