| NPI | 1407887201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: SC 29700) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 057150) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 29700) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TN 53281) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2017-01-13 |