| NPI | 1558532978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX M9493) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX Temporary) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2019-05-17 |