| NPI | 1174605877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: HI 14322) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: HI 14322) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: HI MD-14322) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-02-03 |