| NPI | 1467680124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A12497) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A12497) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A12497) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2021-12-15 |