| NPI | 1144264904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS0004087) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: FL OS4087) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-09-16 |