| NPI | 1013189877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL 112139) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 44335) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2013-07-11 |