NPI | 1962796375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX P9985) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P9985) |
Enumeration Date | 2011-06-02 |
Last Update Date | 2017-12-01 |