| NPI | 1033247218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PR 12268) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PR 12268) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: PR 12268) | |
| 209800000X Legal Medicine (Licence: PR 12268) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-08 |