| NPI | 1104811900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MA 78218) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 78218) |
| 2081N0008X Physical Medicine & Rehabilitation Neuromuscular Medicine (Licence: MA 78218) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MA 78218) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: MA 78218) | |
| Enumeration Date | 2005-09-18 |
| Last Update Date | 2019-04-26 |