| NPI | 1164702130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0102204113) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0102204113) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2026-03-25 |