| NPI | 1306874854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 0424301) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 102052) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 102052) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KS 0424301) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2019-07-29 |