| NPI | 1609940113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301066691) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301066691) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2018-05-31 |