| NPI | 1396747473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX H4878) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: TX H4878) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX H4878) | |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2011-05-12 |