| NPI | 1376528752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0043013) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MD D0043013) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0043013) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD D0043013) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2011-02-27 |