NPI | 1366467797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: DE C1-0005687) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PA MD054290L) |
2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NJ MA06671200) | |
Enumeration Date | 2006-07-13 |
Last Update Date | 2007-07-09 |