| NPI | 1114091105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G76791) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 7678772-1205) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2019-03-18 |