| NPI | 1881909141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 56087) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A14958) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2023-10-17 |