| NPI | 1720030554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 038915) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CT 038915) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CT 038915) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-05-01 |