| NPI | 1114952413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME65248) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME65248) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-10-15 |