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) | |
Enumeration Date | 2006-09-26 |
Last Update Date | 2024-11-14 |