NPI | 1639436496 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD457819) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD457819) |
Enumeration Date | 2012-04-18 |
Last Update Date | 2018-02-01 |