| NPI | 1770665655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VT 420007461) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301067189) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 3056920) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301067189) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2018-10-25 |