| NPI | 1295893782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME0022163) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME0022163) |
| 209800000X Legal Medicine (Licence: FL ME22163) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2010-03-31 |