| NPI | 1790312387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA RN258037) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA RN258037) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-03-24 |