| NPI | 1922532977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 65387) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: AZ 65387) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2024-09-20 |