NPI | 1790913739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX T0883) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10036279) |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T0883) | |
Enumeration Date | 2009-06-29 |
Last Update Date | 2023-06-27 |