| NPI | 1053301119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI SH049112) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301049112) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2021-06-25 |