| NPI | 1508150988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 006708) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2012017428) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: IA DO-04907) | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2021-01-14 |