| NPI | 1629605365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA 104476) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 1017756) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 1017756) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-07-24 |