| NPI | 1477564607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA A46079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A46079) |
| 207RS0010X Internal Medicine Sports Medicine (Licence: CA A46079) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: CA A46079) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2008-05-05 |