| NPI | 1770521585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME159684) |
| Additional Taxonomies | 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: CO 42200) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME159684) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2024-08-28 |