| NPI | 1356886550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TN AT0000001799) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MS AT0637) |
| Enumeration Date | 2016-12-23 |
| Last Update Date | 2016-12-23 |