| NPI | 1104070820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 34079) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 34079) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 34079) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NC 34079) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NC 34079) | |
| 207L00000X Anesthesiology (Licence: NC 34079) | |
| 207Q00000X Family Medicine (Licence: NC 34079) | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2019-02-27 |