| NPI | 1376727289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OK 30288) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2009-01490) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A102864) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2013-10-31 |