| NPI | 1760460828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MA 214568) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 214568) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MA 214568) | |
| Enumeration Date | 2006-01-08 |
| Last Update Date | 2011-10-28 |