| NPI | 1902833817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ AP11653) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP11653) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2024-04-19 |