| NPI | 1386104933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: IA MD-53462) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CA 186584) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-03-31 |