| NPI | 1073877320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301101540) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301101540) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301101540) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2018-03-17 |