| NPI | 1700807732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 27188) |
| Additional Taxonomies | 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: KY 27188) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: KY 27188) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KY 27188) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2007-07-08 |