| NPI | 1902003361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2012-02155) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NC 2012-02155) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-02-17 |