| NPI | 1568967685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX U5475) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: TX U5475) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO 1568967685) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-10-06 |