| NPI | 1063659613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0071228) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301088593) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301088593) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 4301088593) | |
| Enumeration Date | 2009-01-18 |
| Last Update Date | 2022-04-04 |