| NPI | 1427581446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T7049) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2021022115) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX T7049) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2023-03-07 |