| NPI | 1568817864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA RTO000207) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: DE J3-0000526) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2016-12-29 |