| NPI | 1629360508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OK 31264) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.123480) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2022-04-12 |