| NPI | 1770891574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN 4054) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 390200000X) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2021-01-12 |