| NPI | 1043470990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: UT 8627317-1205) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 46108) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2013-08-30 |