| NPI | 1932317260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.143596) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036.158454) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MI 4301099580) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-02-04 |