| NPI | 1992093587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NV 20131) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 297617-1) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 20131) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 297617-1) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2021-12-23 |