| NPI | 1336128388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 10385220-1205) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: UT 10385220-1205) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: UT 10385220-1205) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2018-03-17 |