| NPI | 1265725436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: DC MD045339) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DC MD045339) |
| Enumeration Date | 2011-05-22 |
| Last Update Date | 2022-07-21 |