| NPI | 1295845584 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 052043) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD019395E) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-11-30 |