| NPI | 1710950308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 9501527) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101053048) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AR E-6256) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AR E-6256) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2013-09-25 |