| NPI | 1245987973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI PT20034012) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-03-02 |