| NPI | 1861462798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD0578771L) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: PA MD0578771L) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD0578771L) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2012-11-28 |