| NPI | 1801031885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD443764) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD443764) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD443764) | |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2024-01-15 |