| NPI | 1295874840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME90218) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME90218) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-02-21 |