NPI | 1275053654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 80068-20) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 80068) |
Enumeration Date | 2017-06-26 |
Last Update Date | 2022-07-01 |