NPI | 1114910627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD057416L) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD057416L) |
Enumeration Date | 2005-08-30 |
Last Update Date | 2015-03-26 |