| NPI | 1144458852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: IA MD-42655) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2009016034) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2016-02-15 |