| NPI | 1417116039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD448521) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 241308) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2016-04-28 |