| NPI | 1598952087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL 120485) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G79282) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA G79282) | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2014-11-13 |