| NPI | 1851481162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 53929) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101015974) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2011-08-03 |