| NPI | 1043373533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: OK 17462) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: TN 24746) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TN 24746) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OK 17462) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2009-07-09 |