| NPI | 1508282492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CT 61182) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60575988) |
| Enumeration Date | 2014-03-15 |
| Last Update Date | 2018-08-08 |