| NPI | 1124089453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 43011002325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 28228) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 28228) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 43011002325) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2023-03-20 |