| NPI | 1861665697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0102204904) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WV 2533) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102204904) | |
| Enumeration Date | 2008-04-13 |
| Last Update Date | 2021-11-10 |