| NPI | 1245425057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301510609) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 239483) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 239483) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 51569) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX S7246) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2024-02-15 |