| NPI | 1053492389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 4414) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4414) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A10222) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A10222) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-02-06 |