| NPI | 1154374312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA 044534) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 044524) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-08-13 |