| NPI | 1639304942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KY 04197) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102203436) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KY TP990) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TN 2736) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0102203436) | |
| Enumeration Date | 2009-05-16 |
| Last Update Date | 2018-09-27 |