| NPI | 1598042871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PR 21007) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX R0234) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX R0234) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2018-10-24 |