| NPI | 1255562567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: GA 080012) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT196131) |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2021-03-08 |