| NPI | 1669481578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: PA MD417839) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD417836) |
| 174400000X Specialist (Licence: PA MD417836) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: PA MD417836) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2008-01-07 |