| NPI | 1275851792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NV 17729) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 17729) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 48628) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AZ 48628) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: IA 42982) | |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2022-12-21 |