| NPI | 1558771089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD-463484) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD463484) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2025-07-03 |