| NPI | 1801162862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MA 282861) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 282861) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: ME md21261) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2021-03-22 |