| NPI | 1033103320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 11591) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: PR 11591) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PR 11591) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PR 11591) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2021-03-02 |