| NPI | 1629270095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0026046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0026046) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2008-06-03 |