| NPI | 1609842012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX MD5086) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD424339) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME93460) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2019-03-06 |