| NPI | 1063403848 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SD 4193) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: SD 4193) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2011-01-10 |