| NPI | 1114092897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SC 16635) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 16635) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-08 |