| NPI | 1235668567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 292518) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 274904) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301112717) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 69191) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 292518) | |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2022-07-08 |