| NPI | 1992799704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA G84334) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD170958) |
| 208100000X Physical Medicine & Rehabilitation (Licence: DE C1-0013339) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60538273) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 17609) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME127347) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2020-03-09 |