| NPI | 1952370934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 09855R) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 09855R) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-03-27 |