| NPI | 1588777445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN 161) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 30672) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2013-03-21 |