NPI | 1265725204 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 73338) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD450972) |
Enumeration Date | 2011-05-24 |
Last Update Date | 2023-04-10 |