| NPI | 1932631223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN 65552) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 227168) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-03-07 |