| NPI | 1144284951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: AL D0118) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL D0118) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2013-03-22 |