| NPI | 1396745485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 22003) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: SC 22003) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 200201427) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2021-06-29 |