| NPI | 1932623899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME161518) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 34610) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 67855) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-07-17 |