| NPI | 1245228790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301034191) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301034191) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 4301034191) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2015-12-29 |