| NPI | 1487711123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: UT 6646778-1204) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 8931) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NV DO1390) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2011-01-06 |