| NPI | 1265069967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME168250) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME168250) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-07-28 |