| NPI | 1134284722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: VA 0102049968) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MD H0042015) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2011-04-19 |