| NPI | 1831338151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KY 03504) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OT012163) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2020-11-05 |