| NPI | 1699989731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 53652) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO 46488) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 54993-021) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO 46488) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2021-03-11 |