| NPI | 1861572653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD0000059994) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME44332) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME44332) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2024-11-08 |