| NPI | 1891728036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 6565196-1204) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4452) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2017-11-21 |