| NPI | 1588929566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2017016487) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MO 2017016487) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2018-02-26 |