NPI | 1770710840 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME119606) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD437104) |
208100000X Physical Medicine & Rehabilitation (Licence: NY 263028-1) | |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2013-01080) | |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME119606) | |
Enumeration Date | 2009-06-16 |
Last Update Date | 2021-04-26 |