| NPI | 1043357304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KS 04-34057) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036.125257) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO 50501) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO 50501) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-09-28 |