| NPI | 1598957250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 064379) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD P21939) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2014-05-20 |