| NPI | 1720052442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX J0658) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J0658) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2009-08-19 |