| NPI | 1386633188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 200201121) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200201121) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2016-12-30 |