| NPI | 1013032846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD60319630) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD434765) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036-115660) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2014-02-19 |