| NPI | 1124283825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 193423) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A8115) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL OS 8296) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2008-07-22 |