| NPI | 1063426724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 39963) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: SC 39963) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2016-07-13 |