| NPI | 1013232628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101256842) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0078288) |
| 208100000X Physical Medicine & Rehabilitation (Licence: DC MD042668) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0101256842) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: DC MD042668) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD D0078288) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2021-05-29 |