| NPI | 1518982032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0068463) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D68463) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-09-28 |