| NPI | 1336567007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD486652) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.137255) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA 89500) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OH 35.137255) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: SC 85696) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2024-08-28 |