| NPI | 1821133323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD P20519) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME155546) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MD D0078317) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-01-17 |