| NPI | 1659581551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AL 26711) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 7222871-1205) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AL 27611) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-10-05 |