| NPI | 1538218128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX M4243) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX M4243) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2014-10-10 |