| NPI | 1871750307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 249030) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: UT 870515631) |
| 283X00000X Rehabilitation Hospital (Licence: UT 870515631) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-07-30 |