| NPI | 1104816115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 10309R) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: LA 10309R) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2014-04-01 |