| NPI | 1558676692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2015-01401) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2015-01401) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2016-09-27 |