NPI | 1750849402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 13891956-1205) |
Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 13891956-1205) |
208100000X Physical Medicine & Rehabilitation (Licence: MN 69916) | |
Enumeration Date | 2019-03-12 |
Last Update Date | 2024-07-18 |