| NPI | 1366002511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 330762) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: DC MD210011828) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2025-03-03 |