| NPI | 1972799799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 054789) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 244714) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NH 14150) | |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: CT 054789) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CT 054789) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 244714) | |
| Enumeration Date | 2007-09-16 |
| Last Update Date | 2024-04-24 |