| NPI | 1447338587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME139531) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 2007-01088) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 2007-01088) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2019-05-29 |