| NPI | 1609040534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: HI MD-18474) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: HI MD-18474) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2020-10-05 |