| NPI | 1174633879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G88960) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101255067) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 190195) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-11-08 |