| NPI | 1558557272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA MD.203843) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.203843) |
| Enumeration Date | 2007-09-16 |
| Last Update Date | 2012-06-28 |