| NPI | 1174696363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 200700587) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 058038) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2014-03-04 |