| NPI | 1891722948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A107301) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA08140000) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 64610-20) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2017-03-06 |