| NPI | 1912900994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA MD60187002) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: IN 01046852A) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-05-15 |