| NPI | 1649621442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 291672) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.150868) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2022-06-07 |