NPI | 1255540076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME56218) |
Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME56218) |
Enumeration Date | 2007-05-21 |
Last Update Date | 2010-02-17 |