| NPI | 1578556536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA os003067-L) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA OS003067-L) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2010-01-26 |