| NPI | 1972562783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ AP4276) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5716) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2016-05-16 |