| NPI | 1649488032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: OH 35.098569) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WV 23455) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD431639) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-08-13 |