| NPI | 1942238357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 5988) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: AZ 5988) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-03-06 |