| NPI | 1558592618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PA MD444216) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: VA 0101258344) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: DC MD043451) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2023-11-06 |