NPI | 1104836832 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX L2151) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX L2151) |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OH 34008248) | |
Enumeration Date | 2006-08-08 |
Last Update Date | 2022-07-21 |