| NPI | 1932216694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME99403) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD427037) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2014-01-14 |