| NPI | 1407089410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL UO2219) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 072442) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2015-06-12 |