| NPI | 1144519877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MO 2016012362) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KS 04-38924) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2017-12-05 |