| NPI | 1518033448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX F9728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX F9728) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2012-04-13 |