| NPI | 1639580574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 77066-21) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 1396) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2023-07-05 |