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 |