| NPI | 1902260227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA OP70102133) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 009208) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 009208) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2026-06-01 |