| NPI | 1962796375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX P9985) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P9985) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2017-12-01 |