| NPI | 1477781029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 9169308-1204) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 9169308-1204) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2024-05-17 |