| NPI | 1265720858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 268772) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248396) |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 9382023-1204) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MA 268772) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2017-02-03 |