| NPI | 1053554261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: FL OS13075) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CO 49156) |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2024-02-19 |