| NPI | 1689654089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SC 29492) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 29492) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2019-08-24 |