| NPI | 1992065171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA MD.206644) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA MD.206644) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2021-09-28 |