NPI | 1992090955 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P6717) |
Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P6717) |
Enumeration Date | 2011-06-17 |
Last Update Date | 2016-10-26 |