| NPI | 1275590390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS-9857) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA OS007435L) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-09-02 |