| NPI | 1184680084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME131442) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A46655) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 164348) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2021-02-03 |