| NPI | 1275521981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA MD020663) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: LA MD.020663) |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: LA 020663) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 201002098) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA MD.020663) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2019-09-19 |