| NPI | 1023119526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD 057525-L) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: PA MD057525-L) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 46335) | |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ 46335) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2022-09-13 |