| NPI | 1366622466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AZ 005503) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 005503) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2014-02-28 |