| NPI | 1548250525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KY 38573) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 38573) |
| 225400000X Rehabilitation Practitioner (Licence: KY 38573) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2020-01-02 |