| NPI | 1356340947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX J3119) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX J3119) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2019-08-26 |