| NPI | 1407050404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME109856) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD 440572) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PR 16675) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-11-04 |