| NPI | 1831311679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 201300175) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2013-00175) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-02-02 |