| NPI | 1518120955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 70798) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 7275) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101257597) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2017-04-26 |