| NPI | 1780634469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN MD39397) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101272721) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN MD39397) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101272721) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-03-21 |