| NPI | 1053304519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD046512L) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD046512L) |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: PA MD046512L) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2015-03-24 |