| NPI | 1770898090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301097384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI L1834999) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI L2449674) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2018-06-05 |