| NPI | 1053751032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 12005709-1204) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO DR.0061855) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2025-05-22 |