NPI | 1922539568 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 71779) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 10955781-1205) |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: IL 036155304) | |
Enumeration Date | 2017-03-24 |
Last Update Date | 2022-09-22 |