| NPI | 1760684757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A134602) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A134602) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA A134602) | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2020-01-03 |