| NPI | 1851684997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA OS018917) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA OP60536808) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2022-03-29 |