| NPI | 1871789214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 70183) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL T-10824) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2019-08-07 |