| NPI | 1346242872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 39112) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO 39112) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KS 04-31652) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2009-08-06 |