| NPI | 1164567848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NM A1437-08) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 207006526) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NM A-1437-08) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2013-07-01 |