| NPI | 1962489864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL me76735) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL me76735) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL me76735) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2016-08-15 |