| NPI | 1316988140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2009-00863) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2009-00863) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2020-06-25 |