| NPI | 1033999263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0101279474) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101279474) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0101279474) | |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2023-10-04 |