| NPI | 1780672261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301073467) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301073467) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2013-01-29 |