| NPI | 1649535824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2017012404) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 2017012404) |
| 207R00000X Internal Medicine (Licence: MA 252846) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 4665-850) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 301480) | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2018-02-26 |