| NPI | 1851656771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 54587) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73591) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2021-07-20 |