| NPI | 1740377100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 077308) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301085359) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MI 4301085359) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: MI 4301085359) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2021-06-10 |