| NPI | 1902807621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 33242) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 33242) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 33242) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2014-02-11 |