| NPI | 1265615546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: KY 03100) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 44711-021) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: GA 060836) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-106836) | |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2021-07-29 |