| NPI | 1285896407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD D0074228) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101248968) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD443050) | |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2018-02-21 |