| NPI | 1750736658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D90988) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MD D90988) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2021-08-03 |