| NPI | 1316406580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME162639) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 1316406580) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2026-02-24 |