NPI | 1013996503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WV WV1480) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WV WV1480) |
Enumeration Date | 2006-01-12 |
Last Update Date | 2011-11-21 |