| NPI | 1811151483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PA OS018444) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL OS15339) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2024-10-10 |