| NPI | 1386842763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101261482) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 070145) |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY TP934) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2023-04-13 |