| NPI | 1013336221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL OS17229) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 293376) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 13341) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-01-14 |