| NPI | 1396716395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0040963) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CO 40963) |
| 207T00000X Neurological Surgery (Licence: CO DR.0040963) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2019-10-17 |