| NPI | 1689615973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 31429) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MN 31429) |
| 207Q00000X Family Medicine (Licence: MN 31429) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 31429) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2011-10-04 |