| NPI | 1679563514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 12099) |
| Additional Taxonomies | 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: PR 12099) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PR 12099) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PR 12099) | |
| Enumeration Date | 2005-10-23 |
| Last Update Date | 2022-02-16 |