| NPI | 1245276252 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 2003013364) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2003013364) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2021-02-17 |