| NPI | 1871080879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 13504853-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRM-1704) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 13504853-1205) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2024-10-25 |