NPI | 1366444358 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 9801033) |
Additional Taxonomies | 174400000X Specialist (Licence: NC 9801033) |
Enumeration Date | 2005-08-10 |
Last Update Date | 2012-03-28 |