| NPI | 1497728372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO CDR.0000553) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 82036) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AZ 44220) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-04-19 |