| NPI | 1780144709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 5101026323) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101026323) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-10-08 |