| NPI | 1811957384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN MD26739) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD0000026739) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 041960) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2021-08-10 |