| NPI | 1891729166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS16975) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101016005) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-08-02 |