| NPI | 1528008810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301055009) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301055009) |
| 225400000X Rehabilitation Practitioner (Licence: MI 4301055009) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2015-01-26 |