| NPI | 1649405283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A134845) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CA A134845) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA A134845) | |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2015-09-10 |