| NPI | 1801964630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 34304) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 34304) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2017-09-18 |