| NPI | 1588942155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0102204441) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102204441) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2024-01-07 |