| NPI | 1093836728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IA 38299) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 49735) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IA 38299) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2014-03-26 |