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 |