NPI | 1427396019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 64676) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 64676) |
Enumeration Date | 2013-01-16 |
Last Update Date | 2021-07-24 |