| NPI | 1245727304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A17796) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0068543) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO DR.0068543) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO DR.0068543) | |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2024-11-04 |