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 |