| NPI | 1538235502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO 46857) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO 46857) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-08-12 |