| NPI | 1093705170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 10990008-1205) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI DS065456) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2021-11-19 |