| NPI | 1265648745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MA 247112) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 247112) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 247112) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2011-12-14 |