| NPI | 1144487018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 060727) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 060727) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2011-02-02 |