| NPI | 1982830758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SC 87835) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP20034721) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX P3209) | |
| Enumeration Date | 2009-06-06 |
| Last Update Date | 2022-08-15 |