| NPI | 1972602944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0040702) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO Dr.0040702) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CO DR.0040702) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-03-14 |