| NPI | 1437348711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AL 30966) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AL 30966) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AL 30966) | |
| 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: AL 30966) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2021-02-04 |