| NPI | 1942245733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00031147) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AK 5460) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA MD00031147) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2024-05-29 |