| NPI | 1316146384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD447016) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ME 018910) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2020-05-15 |