| NPI | 1932106895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AL 16871) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 16871) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2013-10-18 |