| NPI | 1588651715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 45121) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WV 16669) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: KY 45121) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WV 16669) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2022-05-05 |