| NPI | 1144333972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD H0074948) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: OR DO23008) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI TC018927) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2012-12-20 |