| NPI | 1467951715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MO 2016027860) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MO 2016027860) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2018-02-01 |