| NPI | 1265415988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD066418L) |
| Additional Taxonomies | 2081P0004X Physical Medicine & Rehabilitation Spinal Cord Injury Medicine (Licence: PA MD066418L) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PA MD066418L) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CO 45421) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2018-09-18 |