| NPI | 1750693065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2016-00380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6310) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0116023430) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 48511) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: AZ 48511) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2020-10-25 |