| NPI | 1831120849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA c141462) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NV 9610) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NV 9610) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 9610) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2018-09-04 |