| NPI | 1174501175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 43012) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT 43012) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CT 43012) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2022-07-11 |