NPI | 1609214253 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX S5111) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX S5111) |
Enumeration Date | 2013-06-05 |
Last Update Date | 2023-08-08 |