| NPI | 1891796595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 73026) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: ID M9189) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2015-04-14 |