| NPI | 1366685497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2016-00737) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101255910) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: DC MD043009) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: DC MD043009) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: DC MD043009) | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2016-10-03 |