| NPI | 1114422359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 76726) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 9409514) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WI 76726) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2022-09-28 |