| NPI | 1780656256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101057941) |
| Additional Taxonomies | 208VP0000X (Licence: VA 0101057941) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2023-08-09 |