| NPI | 1720011331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0045916) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO DR.0045916) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO DR.0045916) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2022-04-27 |