| NPI | 1447242813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 44182) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01059518A) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2012-08-09 |