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 |