| NPI | 1891723375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A9504) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A9504) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A9504) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA 20A9504) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A9504) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2025-01-15 |